First recorded around 1700 B.C. in China, the vector
of malaria (genus Anopheles, known by their posture:
mottled wings and "tail in the air") is the
single biggest cause of death among children worldwide.
Nearly 3,000 children die daily from malaria out of
total annual malaria deaths worldwide of 1.5 million
people (WHO, 1999). The World Health Organization also
estimates that out of the 200 million people affected
by malaria worldwide each year, 70 million are children
under the age of 5. In Liberia, about 4,500 Liberian
children die each year from malaria, writer Abdoulaye
W. Dukulé quoted a Liberian Health Ministry physician
in his article “Life in Monrovia” (The Perspective,
2001). Of course, if we calculated the estimated annual
malaria deaths of 4,500 children for at least 100 years
of Liberia’s 157-year history, we would have lost
450,000 Liberian children to malaria, which is 2.5 times
higher than the 200,000 Liberians who died during the
two recent barbaric civil wars in Liberia between 1989
and 2003.

Perhaps, this is why almost every child growing up in
Liberia, especially in the Liberian capital, Monrovia,
doesn’t only know the name mosquitoes, the parasite
that causes malaria, but also had a first hand dose
of experience with the dreaded disease. “In one
[Liberian] province, at least 50 percent of blood transfusions
were due to malaria induced anemia, particularly in
children five years and below…Most affected by
the malaria parasite in Liberia were children below
five years and pregnant women, especially those carrying
their first pregnancy…. in one year there were
1,570 deaths, 186 were due to malaria, with 101 of the
malaria deaths being children five years and below,”
Dr. Benjamin Vonhn, Director of the Malaria Control
Division at the Liberian Health Ministry told the Pan
African News Agency in an interview on May 10, 2001
(www.republic-of-liberia.com/vol4_no5.).

Malaria is an infectious disease whose symptoms, according
to the American Center for Disease Control and Prevention,
consist of "fever and flu-like illness, including
shaking, chills, headache, muscle aches and tiredness,
nausea, vomiting and diarrhea.” The Greek physician
Hippocrates referenced the dreadful nature of malaria
back in 400s B.C., while malaria was said to have contributed
immensely to the fall s of the Roman and the Greek Empires
(gsbs.utmb.edu/microbook). The ancient centers of civilization
in Iraq, India, Egypt, and China were also said to have
greatly suffered from the presence of malaria. Studies
have also shown that cities built in the 1800s near
swampy areas, lowlands and waterways such as Monrovia
are susceptible to malaria, so do large urban centers
such as Rome in Italy, Philadelphia and New York in
the United States. Notwithstanding, Liberian costal
towns and cities, especially Monrovia, are a hotbed
for malaria because of Liberia’s tropical rain
forests and savannah wetlands, which provide a unique
habitat for the breeding of the malaria-causing parasites,
mosquitoes. Mosquitoes generally prefer to rest in a
cool, damp, dark place located away from the wind. Natural
resting stations include such places as chicken houses,
caves, hollow trees, culverts, under bridges, in stables,
and unscreened housing, in addition to shallow water
pools, puddles, hoof prints, borrow pits, rice fields
or farms. The study, Environmental Health, (1971: New
York: Academic Press) by P. Walton Purdom presents mosquitoes’
breeding habits with a high degree of clarity that throwaway
containers, edges of streams, swamps, marshes, rivers,
ditches, irrigation sites, Mangrove swamps, and other
stagnant waters found near the coastline are mosquitoes’
breeding grounds.

In fact, of the four known species of mosquito (Plasmodium)
parasites that cause malaria worldwide, Plasmodium falciparum,
which causes the most fatal and grave infections, is
the most common species found in Liberia. Plasmodium
falciparum is not only transmitted primarily during
the rainy season months in places such as Liberia, but
it is also the most deadly form of the four species
of malaria-producing mosquitoes. About 90 percent of
malaria deaths and half of all clinical cases of malaria
result from this genus of mosquitoes. “Mosquitoes
located in Africa are more likely to bite and are much
more deadly. Unlike their American counterparts, these
African mosquitoes have longer life span and their bites
are very likely to be infectious” (home.att.net/~africantech/Malaria).
Perhaps, this was one reason why “many liberated
Liberians of Black descendant who returned to Africa
to establish an empire on the West Coast of the Black
Continent did not live to see the nation that supposed
to have been a unique gem in the heart of West Africa
as malaria unfortunately decimated half of the first
88 immigrants (www.earlham.edu/~pols).

A person infected with Plasmodium falciparum-produced
malaria, if not treated promptly and properly, may suffer
kidney failure, seizures, mental confusion, coma or
death. This type of malaria may also cause anemia and
jaundice (yellow coloring of the skin and eyes) because
of the loss of red blood cells. Plasmodium vivax, the
second genus of mosquitoes is the most prevalence or
distributed parasite, living in both temperate and tropical
climates. The third type of mosquito parasites can also
be found in temperate and tropical climates but is less
common than Plasmodium vivax, which “can infect
the liver and persist in a dormant state for months,
or even up to several years, after exposure”(healthlink.mcw.edu/article).
Plasmodium ovale, the fourth type, is a relatively rare
parasite, confined to tropical climates and found principally
in eastern Africa (www.ratsteachmicro.com/Malaria).

All four kinds of mosquitoes can be found in Liberia
because the country’s geological “floorplan”
consists of 43,000 square miles of vast tropical land,
which is heavily rain-forested and receives between
100-180 inches of rainfall annually. Liberia is divided
into four major geographic terrains and vegetation distributions,
including the coastal plain, the belt of rolling hills,
mountain ranges, plateaus and the northern highland.
The country's drier plateau areas receive 70 inches
of rain annually. The annual precipitation along the
coastal region is the heaviest, ranging from 5080 mm
in the northeast to about 2540 mm in the southeast.
While temperature fluctuation is very modest, the dry
season is very short. Inland, precipitation progressively
decreases and the climate is characterized by distinct
rainy and dry seasons. Over 80% of the rainfall takes
place during the rainy season when rains qualls increase
vertical mixing of the atmosphere. The rainy season
is interrupted between July and August by a pronounced
drop in precipitation for about three weeks. The average
daily temperature is 80 degrees Fahrenheit and the average
humidity 70-90 percent depending on the local conditions.
All these conditions lend themselves to breeding mosquitoes
that carry malaria and several other tropical diseases
(Somah, 1994).

The symptomic fever that characterizes malaria inception
occurs when merozoites invade and destroy red blood
cells in the human body. As the destruction of red blood
cells spills wastes, toxins, and other debris into the
blood, the human body responds by producing fever, an
immune response that speeds up other immune defenses
to fight the foreign invaders in the blood. The fever
usually occurs in intermittent episodes, which begins
with sudden, violent chills (or what we called in Liberian
the person trembling), followed by an intense fever
and then profuse sweating. Upon initial infection with
the malaria parasite, the episodes of fever frequently
last 12 hours and usually leave an individual exhausted
and bedridden. Repeated infections with the malaria
parasite can lead to severe anemia, a decrease in the
concentration of red blood cells in the bloodstream
because the malaria parasite usually consumes or renders
unusable the proteins and other vital components of
the infected person’s red blood cells www.ratsteachmicro.com/Malaria).
The pattern of intermittent fever and other symptoms
in malaria varies depending on which species of Plasmodium
is responsible for the infection. Infections caused
by Plasmodium falciparum, Plasmodium vivax, and Plasmodium
ovale typically produce fever approximately every 48
hours, or every first and third day (www.buddycom.com/cells/malaria).
Infections caused by Plasmodium malariae produce fever
every 72 hours, or every fourth day. The hazard, however,
comes when the infected mosquito bites another person,
the mosquito’s sporozoites move through the blood
to the liver of the infected person. The sporozoites
divide repeatedly to form 30,000 to 40,000 merozoites
in liver cells over the course of one to two weeks.
The colony of merozoites departs the liver to enter
the bloodstream, where they invade red blood cells.
While in the blood cells, the merozoites multiply quickly
thereby forcing the red cells to burst, while releasing
into the bloodstream a new generation of merozoites
that go on to infect other red blood cells (www.ratsteachmicro.com/Malaria).

In addition to these grim statistics about incident
of malaria deaths and infestations amongst Liberian
children and mothers, as well as the prevalence of malaria-producing
mosquitoes in Liberia, the Director-General of the World
Health Organization, Dr. Gro Harlem Brundtland, posits
that out of the nearly 300-500 million clinical cases
of malaria recorded worldwide each year, 90% of these
cases occur in Africa. “This is above all the
disease of the poor - killing the young and the weak
mostly living in rural areas in Sub Saharan Africa…
We share the concern of the severe impediment malaria
is putting on the economic and social development of
so many countries. Some studies indicate that malaria
can hold back income by as much as 12%. Where there
is malaria, there is likely to be severe strains on
foreign investments… Most victims of malaria die
simply because they do not have access to health care
close to their home, or their cases are not recognized
as malaria by health care professionals. In addition,
life saving drugs is often not available” (Brundtland,
1999).

Of course, while the WHO director-general’s prognosis
about the human and economic costs of malaria connotes
a universal problem, the malaria problem in Liberia
is acute considering that unlike other nations in Africa
and the world, Liberia has no national project in place
for control or eradication of malaria. And this is why
a national mosquitoes and waterborne diseases control
campaign is imperative for the health and wellness of
Liberians, especially Liberian children and mothers
who are the most venerable groups susceptible to malaria.
Often times, malaria impacts a child’s education,
as it contributes to a high rate of absenteeism from
school. For example, while growing up in Liberia, I
have seen young Liberians inflicted with malaria warming
themselves around the fire place or sitting in the hot
sun because they were physically and mentally weak to
study or walk to school. However, while no studies exist
to determine the exact net effect of malaria on student
absence in Liberian schools, the results of a Kenyan
study on the subject showed that “as many as 11%
of the school days in a year and older students miss
as much as 4% of the school year. The elementary school
students would be missing the equivalent of almost a
month of school in this country. Anyone who has gone
through a school system will know the detrimental effect
that this level of absenteeism could have on your ability
to graduate” (allafrica.com, 2003).

Malaria not only places enormous burdens and strains
on the national healthcare delivery systems in Liberia,
and in other African countries, but also serves as a
major indicator of slow economic development, as it
drives away international investors due to bad publicity.
For example, when 51 US Military Personnel in Liberia
showed signs of malaria, it became household news in
the United States and other parts of the world. This
kind of bad publicity is not good for the national economy
and other socio-economic developments programs in Liberia.
Hence, as Glean McKenzie notes, “The economic
cost of malaria is also high in countries of Africa,
Asia and Latin America where the disease is endemic.”
The World Health Organization estimates that up to $12
billion are lost annually to the disease” (online.middlesex.cc.ma.us),
while Sophie Pons insists that about one million Africans
are not only treated for malaria every year at an estimated
cost of two billion dollars, but the fact that Africa
now needs $1 billion annually to combat malaria after
years of foot dragging in controlling the disease (www.sciencedirect.com).

While we have yet to determine Liberia’s annual
budget due to 14 years of conflict, if Liberia were
to spend $200 million annually on the treatment of
malaria-related diseases, similar to Uganda’s
$210 million malaria treatment budget (allafrica.com),
Liberia would have spent 5000 million on the treatment
of malaria in the last 25 years alone. But this is
a huge financial and human cost overlays that Liberia
might not afford in the next 50 or more years. The
14 years of unprecedented civil wars in Liberia has
led to the displacement of an estimated 600,000 Liberians,
while according to Medicins Sans Frontiers (MSF),
recorded deaths in Liberia resulting from malaria-related
diseases and water-borne diseases during the war years
skyrocketed. MSF said among Liberian children under
five, deaths were “eight per 10,000/day, a figure
two to three times higher than that found in Liberia
during peacetime.” Similarly, the Incident Displaced
People (IDPs) recorded in fall of 2002 that, “53
percent of deaths in the under-fives [in Liberia]
resulting from these same four diseases, i.e., diarrheal,
respiratory infections, measles, and malaria.”
In addition, in his article, “Removing Obstacles
to Effective Malaria Treatment in Emergencies”,
Richard Allen laments that the lack of “Skilled
health staff shortages and inadequate national supplies”
in Liberia, which he said contributed to Liberians
resorting to the use of “CQ intramuscularly
for the treatment of severe malaria cases, an outdated
and dangerous method in the face of rising CQ resistance”
www.globalhealth.org/conference_2002).

It seems to me that Liberians are caught in a catch-22
situation in which they must choose to die from malaria
or subject themselves to unsafe and outdated CQ intramuscularly
treatments for malaria. But all hope is not lost as
long as Liberian national leaders and health officials
take appropriate steps to eradicate malaria in the
same way the United States, China, Cuba, and other
nations did when confronted with menacing effects
of malaria. For example, in 1935 the United States
experienced an estimated 135,000 cases of malaria,
including 4,000 deaths, but the U.S. government launched
a vigorous malaria eradication campaign with a battery
of trained health professionals that eventually paid
off. China, Cuba, and India equally launched vigorous
malaria eradication campaigns with marked successes
by combining political leadership, mass communications,
and both medical and grass roots educational and training
techniques. In addition, India launched a series of
national health campaigns that effectively succeeded
in eradicating the bandicoat rats that destroyed about
one fourth of the country's grain. Of particular note
was India’s reliance on local traditional technique
involving 300 members of the 28,000-strong Irula tribe
- a rare mixture of patriotism and individual empowerment
- to act as a true national resource against the pests.
This effort helped India to secure sufficient meal
to feed its 900 million people.

Liberia therefore needs to emulate the national campaigns
of the United States and other nations, especially
India, in combating malaria in Liberia. Liberia needs
to reconsider its reliance on chloroquine as malaria
treatment by seeking other viable treatment options
for malaria, including ATD and traditional Liberian
herbs. Chloroquine and other malaria treatment drugs
are becoming less effective against malaria, as malaria-producing
mosquitoes are gradually fighting back. According
to Kenyan researcher Kevin Marsh, malaria is no longer
responding to treatments that rely on Chloroquine
and other popular drugs. “The resistance is
spreading fast, and science is running out of time.
‘Nowadays you have resistance all over the continent.
We need to find urgent solutions.’” Marsh
said (www.2001pray.org/Malaria.htm). Like Dr. Marsh,
Dr. Vonhn of the Liberian Health Ministry expressed
similar concern about the resistance of malaria-producing
mosquitoes to treatment. “… In 1996 studies
in three locations showed the southeastern port city
of Buchanan with 38 percent, the capital city Monrovia
with 18 percent and the northwestern border town of
Vahun with five percent…in 1999, two other studies
in the Central Liberian city of Gbarnga and southeastern
Pleebo showed 28 percent and 22 percent resistance
respectively. Plasmodium falciparum resistance to
chloroquine up to 24% has been reported,” he
said (www.republic-of-liberia.com/vol4_no5.htm).
What Can We Do Now

I indicated earlier that hope is not lost in the
treatment or eradication of malaria as long as Liberian
national leaders and health officials summoned the
political will to act by launching vigorous malaria
eradication programs in Liberia. First, a battery
of health inspectors would help with mosquito surveillance
and control programs. The health teams must conduct
appropriate mosquito surveys and determine the right
species of malaria-producing parasites present in
each political subdivision of Liberia, to determine
their abundance and seasonal variations, and to identify
the breeding habits of the various species of mosquitoes
in and around the city areas. Second, the Ministry
of Health could use biological control method to determine
the various species of small fish that mosquitoes
feed upon to create mosquito larvae and pupae and
adult mosquitoes that are eaten by birds, dragonflies,
and bats. The Ministry of Health could develop pools
for raising species that naturally attack mosquitoes
and construct city parks that will attract bats and
birds that feed on mosquitoes. Given this kind of
Integrated Mosquito Control Management Plan (IMCMP),
the high incidence of malaria in Liberia could be
adequately controlled or eradicated knowing the population'
dynamics, the reproductive behavior, seasonal cycles,
and resistant populations of falciparum and malariae
issues. Once this information is known, the Liberian
government can begin sanitation improvement measures,
habitat alteration, cultural practices, reproduction
of harborage and mosquitoes proofing.

Third, our nation should consider the safe application
of DDT, which is 90 percent effective in destroying
mosquitoes and it is cost-effective due to its 90-year
durability. Swiss chemist Paul Hermann Muller invented
DDT in 1937 and it soon emerged as “miracle
chemical” in the treatment of –mosquitoes,
by helping to eradicate malaria in Western Europe
and the North America. However, DDT use in Africa
felt apart in 1962 when environmentalist Rachel Carson
released her book, "Silent Spring," which
dismissed DDT as a poison for the environment rather
than a miracle treatment for malaria. DDT was labeled
as the world’s most toxic substance and eventually
banned, though DDT is not known to have killed anyone.
Other research scientists eventfully questioned Carson’s
conclusion and DDT was restored as a treatment against
malaria-producing mosquitoes. In “Malaria Remains
Real Tyrant” visiting professor Jason Lott of
Oxford University writes, “Recent studies have
shown that DDT is actually less toxic than aspirin
for humans, and the minimal amount needed for protective
indoor spraying will likely have little, if any, environmental
impact. DDT's effectiveness was proven again in 2000,
when South Africa broke rank with environmental standards
and implemented indoor residual spraying of DDT to
end a malaria scare along its border with Mozambique”
(www.humanbeams.com).

“A blight that has been all but eliminated
in the West, malaria still claims between one million
and two million lives every year in the underdeveloped
world. ... The bigger problem is the politicized international
health agencies that discourage the employment of
all available tools of prevention -- specifically
insecticides containing DDT that is anathema to environmentalists,"
The Wall Street Journal noted in a 29 December 2004
edition. In addition, “Roll Back Malaria should
reconsider the role DDT can play in the fight against
malaria. For the most part, “Roll Back Malaria
of 1998” has not met its goals. In his article,
“Day-After Day After Day After Day” by
Dr. Roger Bate, he argued that: “The WHO, World
Bank, the US aid agency, USAid, and Unicef launched
Roll Back Malaria in 1998. Their aim was to reduce
malaria deaths by 2010. So far malaria deaths have
risen 12 %” (www.fightingmalaria.org/article).
If saving as many lives as possible is what truly
matters, then prevention protocols emphasizing the
use of ITNs and DDT must be adopted and implemented
across the region. Vague appeals to environmental
integrity and unfounded warnings of human harm do
not justify the needless deaths of so many, especially
when a solution is near at hand,” the U.S.-based
Roll Back Malaria Campaign said in an article (www.humanbeams.com).

Traditional Treatment
In addition to the Integrated Mosquitoes Control Management
Plan (IMCMP) suggested earlier, DDR and traditional
Liberian herbs could be used in the control of malaria
in Liberia. I have already discussed the success of
DDT in South Africa, so I would suggest that Liberian
health authorities must engage in a national campaign
to learn about all the herbs our people knew and used
to treat malaria that we have abandoned to crave for
western medicine. Instead of cutting down the forest,
we must leave the trees where they are and invite
pharmaceutical companies to test these herbal remedies
as other nations are doing. For example, China for
centuries have a plant called the "sweet wormwood"
that work effectively against malaria. Though it is
not known in the West, the WHO just learned about
the Chinese herb and is now recommending its use of
multi-drug combinations based on artemisinin after
researchers concluded that Africa needs the sweet
wormwood to treat malaria. The Chinese wormwood is
now being mass-produced and sold at affordable prices
to the African people. I believe that we have a Liberian
“sweet wormwood" in our backyards, and
we need to exploit it. For example, a local herb popular
among the Bassa people for treating malaria is the
“deede-chu,” while other popular Liberian
traditional herbs for treating malaria or fever includes
the “jologbo”. These are popular herbs
found among the Bassa people of Liberia, but efforts
should be made to find and catalogue all herbal medicines
used by traditional Liberia in the war against malaria
and other illnesses in Liberia. In the United States
and other developed traditions, herbal medicines use
are on the rise under such names as “herbal
supplements” or “alternative medicine,”
and Liberia as a developing country cannot afford
to overlook its traditional herbal medicines reserves.
Any new governments in Liberia need to encourage the
cataloguing of traditional herbal medicines for purposes
of refinement for use by the general public. And this
is why previous efforts by Isaac Smith, RN at TB Hospital
and biologist Dr. Dickson Redd of the University of
Liberia and his students in cataloging some herbal
plants in Liberia must be resurrected and expanded
as part of a national effort.

Nevertheless, the success of any national health
campaign would depend on two major factors—education
and cooperation, which have been two of Liberia's
greatest challenges. Even now, if Liberian health
authorities were able to mobilize the Liberian people
to embrace a malaria eradication campaign that combined
cultural and individual empowerment similar to the
Indian program, it might still not be possible to
reach Liberians living outside the city centers in
each political subdivision of Liberia. So the first
step is to ensure that the national radio stations
reach every corner of Liberia if we want the full
participation of the Liberian people. In fact, once
we succeed in a vigorous malaria eradication campaign
on our own, the rest of the world will see an opportunity
for investments in Liberia.

RECOMMENDATIONS:

· Clinical
evaluation of our forest trees to produce herbal medicines
or industrial production of anti-malarial drugs from
plants extracts on an industrial scale. Instead of
deforestation, we can preserve our forest and contract
with pharmaceutical companies or find investors and
researchers to partner with our nation’s universities,
laboratories to study anti-malarial plants like “zeechu”
(Bassa)

· National
Health Campaign to rally the people to action

· Involve
the University of Liberia and the nation’s elders
in the identification of useful herbs for the treatment
of malaria

· End deforestation
and contract pharmaceutical companies to begin testing
extracts of trees. In that way Liberia makes money
and still keep the ecology intact

I strongly believe that if a nation and its people
are to participate fully in the bright prospects of
democracy, it is necessary for the people to be healthy
and strong so they can take an active part in nation
building. Nation building is impossible without changed
mindset about national health and sanitation in Liberia.
Combating malaria is not an easy task in Liberia,
given the country’s current political and economic
conditions, but a national health and sanitation campaign
to control wastes and garbage disposals and the construction
of public latrines and sewer disposal systems will
go a long way in controlling the spread of malaria-producing
mosquitoes in Liberia. Above all, we need a new Liberian
leadership that will take the health and wellness
of the Liberian people more seriously, to properly
plan, with respect to effective and efficient sanitary
system, environmental impact surveys, and so forth.
To delay action in the treatment of malaria in Liberia
now, may lead to a drastic turnabout in the future,
which might result in -an expensive proposition--and
this can make it into an extremely intolerable venture.

About the Author: Syrulwa Somah, Ph.D.,
is an Associate Tenured Professor of Environmental and
Occupational Safety and Health at NC A&T State University
in Greensboro, North Carolina. He is the author of:
The Historical Resettlement of Liberia and Its Environmental
Impact, Christianity, Colonization and State of African
Spirituality, and Nyanyan Gohn-Manan: History, Migration
& Government of the Bassa (a book about traditional
Bassa leadership and cultural norms published in 2003).
Somah is also the Executive Director of the Liberian
History, Education & Development, Inc. (LIHEDE),
a nonprofit organization based in Greensboro, North
Carolina. He can be reached at: somah@ncat.edu or lihede@att.net